Case

A 73-year-old retired analytic chemist presented with 4 weeks of epigastric discomfort, weight loss and loose stools. His medical history revealed pancreatic insufficiency on the background of a pancreatic mass, which had resolved 8 years previously, childhood eczema, and shellfish allergy. Laboratory investigation demonstrated an elevated C-reactive protein of 32 mm/L and IgG of 14.8 g/L with negative endomysial and auto-antibodies, normal blood count, liver function and amylase.

CT of the abdomen showed concentric thickening of the ascending colon and caecal wall with serosal abnormality and mesenteric lymphadenopathy (figure 1A, B). Ileocolonoscopy revealed an oedematous and inflamed proximal ascending colon, caecal valve and terminal ileum (figure 2A–C). The transverse colon, left colon and rectum were spared. Colonic biopsies showed an infiltrate rich in lymphocytes and plasma cells, with no granuloma or dysplasia (figure 3A).